Quality of life and survival outcomes of patients with inoperable esophageal squamous cell carcinoma after definitive radiation therapy:A multicenter retrospective observational study in China from 2015 to 2016

Objectives:To investigate the health-related quality of life(HRQL)of long-term survivors of inoperable esophageal squamous cell carcinoma(ESCC)treated with definitive radiation therapy,the real-world trends in the use of advanced radiation techniques,and their impact on the survival outcomes of ESCC patients.Methods:In this multicenter retrospective observational study,the medical records related to demographics and treatment of ESCC patients who were treated with definitive radiation therapy at 14 provincial hospitals in China from 1 January 2015 to 31 December 2016 were analyzed.A HRQL questionnaire was completed by survivors and collected by doctors at the final follow-up.The difference in quality of life between patients with or without recurrence was compared using the Wilcoxon-Mann-Whitney test.Overall survival(OS)was estimated using the Kaplan-Meier method and the group differences were assessed by unstratified log-rank test.The Cox proportional hazards model with Efron’s method of tie handling was used to calculate the risk factors for OS.Results:The data of a total of 3,308 patients were collected for this study,248 were excluded because of missing data,and a final of 3,060 patients were included in the analysis.Most patients(2,901;94.8%)received intensity-modulated radiotherapy(IMRT)/volumetric-modulated arc therapy(VMAT)/tomotherapy(TOMO).The 5-year OS rate was 30%.Patients who received either two-dimensional radiotherapy(2DRT;HR,2.43[95%CI,1.70-3.47];P<0.001)or three-dimensional radiotherapy(3DRT;HR,1.45[95%CI,1.14-1.84];P=0.003)had a significantly increased risk of death compared to those who received IMRT/VMAT/TOMO.Of the 716(23.4%)long-term survivors who completed the HRQL questionnaire,nearly 70%patients were still able to swallow normally or almost normally,and>80%patients did not experience weight loss.Nearly 80%patients found life very enjoyable or were fairly enjoying life.Conclusions:This large,multicenter retrospective study on ESCC patients who received definitive radiation ther-apy found that most ESCC survivors are satisfied with their quality of life.Most patients received advanced radiation technology.Patients who received either 2DRT or 3DRT had a significantly increased risk of death compared to those who received advanced radiation technology.

Real-world treatment patterns and clinical outcomes in EGFR-mutant locally advanced lung adenocarcinoma:A multi-center cohort study

Objective:To investigate the optimal management of patients with epidermal growth factor receptor gene(EGFR)mutant locally advanced non-small cell lung cancer(LA-NSCLC).Methods:Patients with unresectable stage III lung adenocarcinoma(LAC)harboring EGFR mutations from 2012 to 2018 were analyzed retrospectively,and were categorized into three groups according to the primary treat-ment:chemoradiotherpy(CRT)(group 1),combined radiation therapy(RT)and EGFR-tyrosine kinase inhibitors(TKI)with/without chemotherapy(group 2),and EGFR-TKI alone until tumor progression(group 3).Inverse probability of multiple treatment weighting(IPTW)of propensity score was used to compare overall survival(OS)and progression free survival(PFS)between treatments and account for confounding.Results:A total of 104,105,and 231 patients were categorized into groups 1,2,and 3,respectively.After IPTW adjustment,the median PFS for each group was 12.4,26.2,and 16.2 months(log-rank P<0.001),and the median OS was 51.0,67.4 and 49.3 months(log-rank P=0.084),respectively.Compared with those in group 1,patients in group 2 had significantly improved PFS[adjusted hazard ratio HR(aHR),0.40;95% confidence interval(CI):0.29,0.54;P<0.001]and OS(aHR,0.61;95%CI:0.38,0.98;P=0.039).Patients in group 3 had prolonged PFS(aHR,0.66;95%CI:0.50,0.87;P=0.003),but not OS(aHR,0.90;95%CI:0.62,1.32;P=0.595).Doubly robust IPTW analysis and multivariable Cox regression analysis yielded similar findings.Conclusions:EGFR-TKIs after chemoradiation or combined with radiation alone correlated with the longest PFS and OS(versus CRT or TKIs alone)in patients with EGFR-mutant unresectable LA-NSCLC.Well-designed prospec-tive trials were warranted.